If you or someone you care for has been told they have heart failure, this page explains what that means, the medications your doctor may prescribe, and what to watch for at home. It is not medical advice — your GP and cardiologist know your situation.
Severe breathlessness, especially when lying flat or waking up gasping
Chest pain or pressure, particularly if it spreads to jaw, arm or back
Coughing up pink frothy sputum
Fainting, severe dizziness, or palpitations that won’t settle
Rapid weight gain (more than 2 kg in 2–3 days)
What “heart failure” actually means
The name is misleading. Heart failure does not mean your heart has stopped or is about to stop. It means your heart isn’t pumping as effectively as it should, so blood and fluid can build up in your lungs, legs, or other parts of your body. With modern treatment, most people with heart failure live with it as a long-term condition that’s well-controlled.
There are different types, based on a measurement called ejection fraction (the percentage of blood the heart pumps out with each beat — a normal value is around 55–65%):
HFrEF — reduced ejection fraction (40% or less). The heart muscle is weaker than normal. The strongest evidence-based treatments apply here.
HFmrEF — mildly reduced (41–49%).
HFpEF — preserved ejection fraction (50% or more). The heart still pumps normally but doesn’t fill properly — often related to long-standing high blood pressure, diabetes, or obesity.
Why four medications?
If you have HFrEF (the most common type), Australian guidelines now recommend four classes of medication — sometimes called the “four pillars” of heart failure therapy. Each one works in a different way, and together they reduce the risk of dying from heart failure by around 60% compared to no treatment. That’s why your GP and cardiologist want you on all four if possible — not because your heart failure is worse, but because each medicine helps in a different way.
1. An ACE inhibitor, ARB, or ARNI
Relaxes blood vessels and reduces the strain on the heart. Common Australian names: perindopril, ramipril, candesartan, sacubitril/valsartan (Entresto). Your blood pressure and kidneys are checked when starting and during dose changes.
2. A heart-failure-specific β-blocker
Slows the heart rate so the heart fills better. Only certain β-blockers are right for heart failure: bisoprolol, carvedilol, metoprolol-XL or nebivolol. Started at low doses and increased slowly — this is why your dose may keep going up over weeks and months.
3. An MRA (mineralocorticoid receptor antagonist)
Helps your body get rid of excess salt and water and protects the heart from further damage. Common names: spironolactone, eplerenone. Your potassium and kidney function are checked when starting and during dose changes.
4. An SGLT2 inhibitor
Originally developed for diabetes, but now strongly recommended for heart failure even without diabetes. Helps the heart in several ways at once. Common Australian names: dapagliflozin (Forxiga), empagliflozin (Jardiance). PBS-subsidised for heart failure.
A few people may be on a fluid tablet (diuretic) such as furosemide on top of the four pillars — this helps with symptoms when there’s congestion. It doesn’t treat the heart failure itself, but it helps you feel better. Take it as your doctor advises — usually in the morning to avoid having to get up at night.
What if I have HFpEF?
If your ejection fraction is preserved (50% or more), the picture is a bit different. SGLT2 inhibitors are still strongly recommended — they’re the one class with the best evidence in HFpEF too. The rest of the focus is on treating the underlying conditions that drive HFpEF: high blood pressure, diabetes, atrial fibrillation, obesity, sleep apnoea. Your GP will work with you on these.
What to do at home, every day
Weigh yourself every morning, after you go to the toilet but before breakfast, in the same clothes (or no clothes). Write it down. A gain of more than 2 kg over 2–3 days means fluid is building up — call your GP.
Take your medicines exactly as prescribed. Don’t skip doses — even if you feel well. Heart failure medicines work over time and need to be taken regularly to keep working.
Limit fluid intake to around 1.5–2 litres per day (or what your doctor tells you).
Limit salt — under 2 grams of sodium per day. Avoid adding salt at the table, watch out for hidden salt in processed foods, takeaway, sauces, soups. The salt intake calculator can help.
Stay active. Gentle daily exercise — walking, swimming, gardening — helps your heart. Cardiac rehabilitation programs (free or low-cost through Medicare) are excellent — ask your GP.
Get your annual flu vaccine, COVID and pneumococcal as recommended — infections can trigger heart failure flare-ups.
Limit or avoid alcohol. Alcohol weakens the heart muscle.
Stop smoking if you smoke — this is the single biggest thing you can do for your heart and lungs. Quitline 13 7848.
When to call your GP (not urgent)
Weight up by more than 2 kg over 2–3 days
Increasing leg or ankle swelling
Getting more breathless than usual on activities you normally manage
Needing more pillows to sleep, or waking at night feeling short of breath
Persistent dry cough, especially worse lying down
New side effects from a medication — dizziness, faintness, lightheadedness
You’re unwell with vomiting, diarrhoea, or dehydration — some HF medicines may need to be held briefly (“sick day” rules — ask your GP about this in advance)
Common questions
Several heart failure medicines — especially the β-blocker and the ACE inhibitor / ARB / ARNI — are started at very low doses and slowly increased over weeks to months. The reason is that going up too fast can drop your blood pressure or heart rate too much. The doses tested in research trials — called “target doses” — gave the biggest survival benefit, so your doctor is aiming for those if your body can tolerate them. This is normal — not a sign things are getting worse.
Where possible, yes — for HFrEF. Each one helps in a different way, and the four together cut your risk of dying or being hospitalised by around 60% compared to no treatment. Some people can’t tolerate one of them because of low blood pressure, kidney issues, allergy, or other reasons — your GP and cardiologist will work out what’s best for you individually. If you’re on three of the four, that’s still much better than none.
Feeling fine is exactly what we want — and it’s usually because the medicines are working. Heart failure tends to slowly worsen over time when untreated, even if you feel okay day to day. The medicines slow that progression and reduce the chance of being admitted to hospital with a flare-up. If you stop, the protection stops — sometimes within days. Always talk to your GP before stopping or changing anything.
Alcohol weakens the heart muscle directly. If your heart failure was caused by alcohol, the recommendation is to stop completely — the heart can often recover. For other types of heart failure, the Australian Heart Foundation recommends keeping alcohol to a minimum (no more than 10 standard drinks per week, with two alcohol-free days). Less is better.
Cardiac rehabilitation programs are one of the most effective things you can do — they reduce hospital readmissions, improve fitness, and help you understand your condition. Most are free or low-cost, run through public hospitals or community health centres. Ask your GP for a referral, or call the Heart Foundation Helpline on 13 11 12.